I got permission from Gianna Kali at Beyond Meds, to reprint her post in its entirety. This is a must read for anyone who has just been told they are certifiably crazy, and for those who are there to remind them that they are. (Please send this to a medical student you may know.)
Listening to Psychosis (or other forms of mental anguish)
April 6, 2007
Knowing what I know now about outcomes for schizophrenics, or people experiencing delusions, who are listened to, who are not told their delusions are crazy or wrong–that many of these people who are taken seriously recover, I often wonder what would have happened had someone listened to my (drug-induced) delusions. If it had not been assumed I was crazy–if I had not been coerced into believing I was crazy. What would have happened if I was taken seriously? I will never know, but there is plenty of evidence that had I been listened to and had my psychotic thinking been explored with respect I may have never entered the world of psychiatric care as we now know it. I again remind you of Soteria House.
I might add, that I finally, took myself seriously. Stopped dismissing the “crazy” for meaningless. That was when my healing began.
Below is a story of a woman, not terribly different than me. In fact we shared a common delusion. We were both to be the mother of the second coming of Christ. She was 18, I was 19. She was listened to by a kind clinician and released from the hospital vastly improved. I was belittled, and humiliated and drugged into a stupor. The rest is history.
Here is an account of the story as told by Al Seibert, Ph.D:
When I was a staff psychologist at a neuropsychiatric institute in 1965, I conducted an experimental interview with an 18-year-old woman diagnosed as “acute paranoid schizophrenic.” I’d been influenced by the writings of Carl Jung, Thomas Szasz, and Ayn Rand, and was puzzled about methods for training psychiatric residents that are unreported in the literature. I prepared for the interview by asking myself questions. I wondered what would happen if I listened to the woman as a friend, avoided letting my mind diagnose her, and questioned her to see if there was a link between events in her life and her feelings of self-esteem. My interview with her was followed by her quick remission.This account raises important questions about:
1. the powerful influence of the interviewer’s mind set and way of relating to patients perceived as “schizophrenic,”
2. aspects of psychiatric training and practices that have never been researched,
3. why psychiatrists misrepresent what is scientifically known about “schizophrenia,” and
4. why the psychiatric literature is silent about the personality characteristics of people who fully recover from their so-called “schizophrenia” and the processes by which they recover.
One morning the head nurse of the locked ward reported the admission of an 18-year-old woman. The psychiatric resident who admitted her the previous evening said “Molly’s parents brought her in. They told us Molly claims God talked to her. My provisional diagnosis is that she is a paranoid schizophrenic. She is very withdrawn. She won’t talk to me or the nurses.”
For several weeks the morning reports about Molly were the same. She would not participate in any ward activities. She would not talk to the nurses, her case worker, or her doctor. The nurses couldn’t get her to comb her hair or put on make-up.
Because of her withdrawal and lack of response to staff efforts, the supervising psychiatrist, David Bostian, told the resident in charge of Molly to begin plans to commit her to Ypsilanti State Hospital. Bostian said the university hospital was a teaching facility, not one that could hold patients who need long-term treatment. The staff consensus was that she was so severely paranoid schizophrenic she would probably spend the rest of her life in the back ward.
I decided that since she was headed for the “snake pit,” this was an opportunity to interview a psychiatric patient in a way very different from how I’d been trained in my clinical psychology program. I asked Molly’s doctor, a third-year resident, for permission to administer some psychological tests and interview her before she was transferred to the state hospital. The resident said I could try, although she expected nothing to come of my efforts.
I contacted the head nurse and arranged to meet with Molly the next morning in the ward dining room. At home that evening I prepared myself for the interview with Molly by reflecting on a cluster of the following four issues and concerns:
1. After reading The Myth of Mental Illness by Thomas Szasz (1961), I began to notice that the only time I saw “mental illness” in anyone was when I was at the hospital wearing my long white coat, working as a psychologist. When I was outside the hospital I never thought of anything people said as “sick,” no matter how outrageous their words or actions. I found it interesting that my perception of “mental illness” in people was so situationally influenced.
2. I’d been puzzled about an unresearched, unreported aspect of the way psychiatric residents talked to newly admitted mental patients. At our institute the psychiatric residents were required to convince each of their patients that they were “mentally ill.” I was present in the office of a resident, for example, during a shouting match with a patient….
….As I prepared myself for my interview with Molly the next day, I developed four questions for myself:
1. What would happen if I just listen to her and don’t allow my mind to put any psychiatric labels on her?
2. What would happen if I talk to her believing that she could turn out to be my best friend?
3. What would happen if I accept everything she reports about herself as being the truth?
4. What would happen if I question her to find out if there’s a link between her self-esteem, the workings of her mind, and the way that others have been treating her?…..
….I felt a rapport with her and felt that I could start a conversation. It went like this:
A.S.: “Molly?…(she looks up at me)…I am curious about something. Why are you here in a psychiatric hospital?”
Molly: “God spoke to me and said I was going to give birth to the second Savior.”
A.S.: “That may be, but why are you here in this hospital.?”
Molly: (startled, puzzled) “Well, that’s crazy talk.”
A.S.: “According to whom?”
A.S.: “Did you decide when God spoke to you that you were crazy?”
Molly: “Oh. No. They told me I was crazy.”
A.S.: “Do you believe you are crazy?”
Molly: “No, but I am, aren’t I.” (dejected)
A.S.: “If you will put that in the form of a question, I’ll answer you.”
Molly: (slightly puzzled, pauses to think) “Do you think I am crazy?”
Molly: “But that couldn’t have happened, could it?”
A.S.: “As far as I am concerned, you are the only person who knows what happens in your mind. Did it seem real at the time?”
Molly: “Oh yes!”
A.S.: “Tell me what you did after God spoke to you.”
Molly: “What do you mean?”
A.S.: “Did you start knitting booties and sweaters and things?”
Molly: (laughs) “No, but I did pack my clothes and wait by the door several times.”
Molly: “I felt like I would be taken someplace.”
A.S.: “It wasn’t where you expected, was it!”
Molly: (laughing) “No!”
A.S.: “One thing I’m curious about.”
A.S.: “Why is it that of all women in the world, God chose you to be the mother of the second Savior?”
Molly: (breaks into a big grin) “You know, I’ve been trying to figure that out myself!”
A.S.: “I’m curious. What things happened in your life before God spoke to you?”
It took about 30 minutes to draw out her story. Molly was an only child who had tried unsuccessfully to earn love and praise from her parents. They only gave her a little love once in a while, just enough to give her hope she could get more. She voluntarily did many things around the house such as cooking and cleaning. Her father had been a musician so she joined the school orchestra. She thought this would please him. She practiced hard and the day she was promoted to first chair in the clarinet section, she ran home from school to tell her father. She expected him to be very proud of her, but his reaction was to smash her clarinet across the kitchen table and tell her, “You’ll never amount to anything.”
After graduation from high school, Molly entered nursing school. She chose nursing because she believed that in the hospital the patients would appreciate the nice things she would do for them. She was eager and excited about her first clinical assignment, but it turned into a shattering experience. The two women patients she was assigned to criticized her. She couldn’t do anything right for them. She felt “like the world fell in.” She ran away from school and took a bus to the town where her high school boyfriend was in college. She went to see him, but he told her to go home and write to him. He said they could still be friends, but he wanted to date other girls.
A.S.: “How did you feel after that?”
Molly: “Awful lonely.”
A.S.: “So your dad and mom didn’t love you, the patients were critical and didn’t like you, and your boyfriend just wanted to be friends. That made you feel very sad and lonely.”
Molly: (head down, dejected) “Yes, there didn’t seem to be anyone in the whole world who cared for me at all.”
A.S.: “And then God spoke to you.”
Molly: “Yes.” (quietly)
A.S.: “How did you feel after God gave you the good news?”
Molly: (looks up, smiles warmly at me) “I felt like the most special person in the whole world.”
A.S.: “That’s a nice feeling, isn’t it?”
Molly: “Yes, it is.”
(The kitchen crew came into the dining room to set up for lunch.)
A.S.: “I must go now.”
Molly: “Please don’t tell them what we’ve been talking about. No one seems to understand.”
A.S.: “I know what you mean. I promise not to tell if you won’t.”
Molly: “I promise.”
Two days later I was walking through the locked ward to see another patient. When Molly saw me she walked over and stopped me by putting her hand on my arm. “I’ve been thinking about what we talked about,” she said. “I’ve been wondering. Do you think I imagined God’s voice to make myself feel better?”
She surprised me. I didn’t intend to do therapy, but she seemed to see the connection. I paused. I thought to myself “maybe so, but if there is an old-fashioned God who does things like this, then He is watching! I didn’t care what the other doctors and nurses do, I am not going to give her a rough time. I am going to be her friend!” I shrugged my shoulders. I said, “perhaps” and smiled at her. She smiled back with good eye contact, then turned and walked away.
At staff rounds the head nurse reported a dramatic improvement in Molly. She was now a cheerful, talkative teen-ager. She spoke easily with her doctor, the nurses, and other patients. She started participating in patient activities. She brushed and combed her hair, put on make-up, and asked for nicer looking dresses.
At rounds a week later Dr. Bostian described her amazing recovery as “a case of spontaneous remission.” The plans to commit her were dropped. A few days later she was transferred to the open ward and she did so well the doctors and nurses expected her to be discharged soon. I left the hospital soon after, so I was not able to follow-up. What would have happened to her if I had not taken time to listen to her with an open mind and affirm her reality? The psychiatric staff’s prediction that she was destined to spend many years in the back ward of the state hospital would, most likely, have been validated.
I don’t know exactly what was going on with me at the time of my psychosis. The circumstances leading to my disturbed thinking may have been very different than Molly’s, but I know that how I was treated in the hospital was incredibly disrespectful and humiliating, much like she was being treated before Seibert interviewed her. One psychiatrist scoffed at me when I told him God had spoken to me. I, too, was threatened with state institutionalization if I didn’t admit I was permanently damaged and didn’t agree to a life-time on meds. I remember the impact it had on me. I felt scalded and deeply ashamed. I exited that hospital with my spirit shattered. I had been an outgoing, confident socializer. I left emotionally immobilized and so insecure that I had difficulty conversing with anyone for a long time after that. A painful insecurity left me stumbling over words and feeling hideously on display for all to see how sick I was. I felt marked, branded for the severely fundamentally flawed person that I was. That mark has stayed with me for two decades. It was not apparent to anyone else for much of those years that anything was wrong with me. I had a full career as a social worker. But I never again felt whole. I never again felt unbranded, normal or healthy. I can’t say I’ve completely recovered from it. I am, just now, beginning to recover as I take my life back from psychiatry. My self-esteem has reached heights I never thought it could in just the last ten months since I began to question psychiatry and how I was treated.
We don’t know what happened to Molly. She may have gone back into an oppressive situation and relapsed. She may not have had another clinician who treated her respectfully. That is what happened to me. I was continually told I was sick by everyone who had any influence on me–family and doctors–and needed to comply with oppressive and disrespectful treatment. My prognosis as told to me was poor. And so I remained in the psychiatric system. But as Soteria House shows people who are encouraged to heal and believe they are not crazy do heal and move on to have successful lives. The tragedy is that the vast majority of people who have a psychosis or anguishing mental event are not given the opportunity to work through it. Drugs halt any natural process of recovery and freeze people in a static hell from which few are lucky enough to extract themselves. Emotional, psychological, and spiritual growth is slowed to a snails pace. Clearly some people do extract themselves sometimes and it is because of the incredible flexible nature of our psyches and spirits that some people are able to do this. But too many are not. I do not know what graced me to be able to extract myself from the lies I was fed. I feel lucky, but otherwise no different from the millions of people who are not able to do so. I did in the end have friends and family who supported me and believed in me but not until I had proved that I could function to some extent through the drug haze–many people cannot function through the drug haze. Somehow, I achieved some credibility and now no one is telling me I can’t do it. My current psychiatrist, my therapist, my neuropsychologist, my husband, family and friends all believe I can live without drugs.
How did I get here? I never gave up and I’m blessed with a fighting spirit. I never did completely accept my pronounced fate. I always doubted in some deep recess of my mind that I was incurable and fundamentally impaired. I did not completely, without a doubt, accept my diagnosis and I did not accept that the quality of life I led on drugs was all I would ever have. I continued to dream of a better life. And now I am beginning to live it. Many people’s dreams are permanently squashed and they die never experiencing a sense of well-being. This is an outrage. This is why I harbor anger and resentment. I see my fellow sufferers trapped with no one to help them. At this point my anger is slowly changing to a passion that propels me forward. I don’t actually believe that every bit of anger must be extinguished. It must just be transformed to compassion and love. And then I hope it will be a furious power for change. Perhaps it already is.